― 75 ― Tokai J Exp Clin Med., Vol. 32, No. 3, pp. 75-77, 2007 Left breath sounds were diminished, and subcutaneous emphysema was present in the left chest. In addition, he complained of back pain, and a lumbar compres- sion fracture was found. Blood gas analysis yielded a PaCO 2 of 34 torr and PaO 2 of 63 torr. Initial plain chest roentgenography revealed left pneumothorax with mild deviation of the mediastinal shadow toward the right, indicative of tension pneumothorax. The left upper lobe was mildly collapsed, and a small macular infiltrative shadow was seen in the left upper lobe. The left lower lobe showed generally decreaed radiolucency in the left thoracic cavity, suggesting mild intrathoracic hemorrhage. These findings led to a diagnosis of left DPL (Fig. 1). 10 minutes after arrival We inserted a drainage tube in the left thoracic cavity, and 500 mL of blood was obtained. However, the patient’s respiratory status worsened rapidly; we performed tracheal intubation and started artificial ventilation. 50 minutes after arrival Although we transfused 2,000 mL of crystalloid, 20 units of concentrated red cells, and 5,250 mL of 5% albumin preparation, a shock state developed; systolic blood pressure was 40 mmHg. Meanwhile, the volume of blood from the left drainage tube reached 1,000 mL, and we clamped the tube. Plain chest roentgen- A Case of Deep Pulmonary Laceration Associated With Blunt Chest Trauma Treated by Emergency Room Thoracotomy Ryota MASUDA, Tomoki NAKAGAWA, Atsushi HAMAMOTO, Yoshimasa INOUE, Masayuki IWAZAKI and Hiroshi INOUE Department of Surgery, Tokai University School of Medicine (Received May 23, 2007; Accepted June 11, 2007) A 30-year-old man fell from the fourth floor of a building and suffered a chest injury. He was transported to our hospital within 50 minutes. Chest roentgenography showed left hemopneumothorax and a shift of the mediastinal shadow to the right. Furthermore, most of the left upper lobe did not appear collapsed, and an infiltrative shadow and light macular shadows were noted. These findings led to a diagnosis of deep pulmonary laceration. The volume of blood in the left drainage tube reached about 1,000 mL within 1 hour. Therefore, we performed emergency room thoracotomy (ERT) and clamped the pulmonary hilum manually. We then moved him to an operating room. Upon surgery, we found extensive laceration of the whole lung, and left pneumonectomy was necessary. He was discharged on hospital day 58. ERT and pulmonary hilum clamping may improve the survival of patients with deep pulmonary laceration and uncontrollable pleural hemorrhage. Key words: Emergency room thoracotomy, Pulmonary hilum clamp, Deep pulmonary laceration INTRODUCTION Deep pulmonary laceration (DPL) associated with blunt chest trauma is a serious wound; the main clini- cal condition is a shock state with hemorrhage and hypoxemia. Because this condition can worsen imme- diately and become fatal, early initiation of treatment is imperative. Treating the shock state and hypoxemia with a pulmonary hilum clamp is the most important step. If the initial treatment of DPL is based on ac- curate diagnosis by prompt assessment and diagnostic imaging, the patient’s life can be saved. We describe a case of DPL treated successfully by emergency room thoracotomy (ERT) and a hilum clamp. CASE REPORT The patient was a 30-year-old man. In November 2001, he fell from the fourth floor of a building (ap- proximately 10 meters) and suffered a chest injury. When emergency services arrived, he was lying in the dorsal position on the lawn and experiencing chest pain. He was transported to our hospital within 50 minutes from the time of injury. On arrival The patient’s Glasgow Coma Scale score was 4-5-6; respiratory rate, 42 breaths per minute; systolic blood pressure, 80 mmHg; pulse rate, 132 beats per minute. Ryota MASUDA, Department of surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan Tel: 81-(0)463-93-1121(Ext. 2280) Fax: 81-(0)463-95-7567 E-mail: masudar@is.icc.u-tokai.ac.jp